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The Case Manager's Corner is intented to provide a brief description of shoulder and knee conditions that commonly occur in the work place. Information on treatment options and time to maximum medical improvement is provided.
Please note: every case is unique and the information provided here is only intended to provide a guideline describing the evaluation and treatment of these conditions.
| Mechanism of Injury |
Often results from non-contact, low-velocity, deceleration, and rotational injuries to the knee. Valgus, external rotation or hyperextension forces are the most common. |
| Symptoms |
Acutely, most patients hear or feel a pop at the time of injury. Patients may develop a swollen knee. The patient may complain of knee instability- or giving way of the knee. An isolated ACL tear is rarely painful. Pain may be associated with concomitant meniscal tears, collateral ligament tears, bone bruising, or articular cartilage damage. |
| Diagnosis |
Ligamentous instability can be measured using the Lachman or pivot shift tests. MRI is often used to confirm the diagnosis and to detect meniscal pathology, which may be present in 60-70% of ACL injuries. |
| Natural History |
Depends upon patient demands and associated injuries. Higher demand patients (i.e. athletes, laborers) often cannot "cope" without and ACL, and they may complain of recurrent instability. Repeat episodes of instability may lead to further meniscal damage, articular cartilage injury and possibly arthritis. |
| Non-Surgical Treatment |
Activity modification and physical therapy |
| Surgical Treatment |
Pre-operative physical therapy to regain extension and quadriceps control and to minimize swelling is essential. ACL reconstruction can be done using a bone-patellar tendon-bone autograft, hamstring autograft or allograft. Postoperative physical therapy is required to regain range of motion and strength. |
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MMI |
Work Status until MMI |
| Non-Surgical: |
Approximately 6-8 weeks |
Avoid sudden directional changes |
| Surgical: |
Approximately 3-6 months |
Avoid cutting, pivoting, twisting activities |
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